1. Clinical Overview
A parenteral nutritional supplement combining a concentrated, hydrolyzed extract of porcine or bovine liver with Thiamine Hydrochloride (Vitamin B1). The liver extract provides a rich source of essential amino acids, peptides, nucleotides, and other hepatotrophic factors, while thiamine acts as a critical coenzyme in carbohydrate metabolism. It is primarily used as a hepatoprotective and restorative agent, as well as for nutritional support in conditions of deficiency and convalescence.
| Onset | Duration | Bioavailability |
|---|---|---|
| The onset of action for the thiamine component is rapid, with biochemical effects beginning within hours. The restorative effects of the liver extract on hepatic function and nutritional status are typically observed over days to weeks of therapy. | The duration of action for thiamine is variable, dependent on body stores and dietary intake. The effects of liver extract are cumulative and sustained with regular administration. | For the injectable form, bioavailability is considered 100% as it is administered parenterally, bypassing first-pass metabolism. |
2. Mechanism of Action
The combination exerts a dual mechanism: 1) **Liver Extract**: Provides pre-digested proteins, essential amino acids (like methionine, cysteine), peptides, choline, inositol, and anti-fatty liver factors. These serve as building blocks for hepatic regeneration, promote protein synthesis in hepatocytes, and may have lipotropic effects (preventing/ reducing fatty infiltration of the liver). 2) **Thiamine (Vitamin B1)**: As thiamine pyrophosphate (TPP), it acts as an essential coenzyme for key reactions in carbohydrate metabolism (pyruvate dehydrogenase, transketolase, alpha-ketoglutarate dehydrogenase complexes), crucial for energy production in all cells, including hepatocytes.
3. Indications & Uses
- Nutritional support in chronic liver disorders (e.g., alcoholic liver disease, cirrhosis, fatty liver)
- Adjunctive therapy in convalescence after illness/surgery where nutritional intake is poor
- Management of thiamine deficiency states (e.g., beriberi, Wernicke's encephalopathy - though higher doses are needed for treatment)
4. Dosage & Administration
Adult Dosage: 1 ml to 2 ml by intramuscular injection, once daily or on alternate days, as directed by the physician. Deep IM injection into the gluteal muscle is standard.
Administration: For intramuscular use only (unless specified for IV by a specialist). Use a deep IM injection, preferably in the upper outer quadrant of the gluteus maximus. Rotate injection sites. Aspirate before injection to avoid intravascular administration. Do not mix with other injections in the same syringe. The solution should be clear; do not use if cloudy or precipitated.
5. Side Effects
Common side effects may include:
- Pain, tenderness, or induration at the injection site
- Mild transient fever or feeling of warmth
6. Drug Interactions
| Drug | Effect | Severity |
|---|---|---|
| Neuromuscular Blocking Agents (e.g., Succinylcholine) | Thiamine may potentiate the action of these agents. | Moderate |
| Loop Diuretics (e.g., Furosemide) | May increase renal excretion of thiamine, potentially reducing its efficacy. | Moderate |
| Alcohol (Chronic use) | Impairs thiamine absorption and utilization, increasing requirement. This is a key indication for the combination. | Major |
7. Patient Counselling
- Do inform your doctor about any allergies, especially to pork/beef products or previous injections.
- Do report any pain, swelling, or redness at the injection site.
- Do not stop the injections abruptly if prescribed a course.
- Do not self-administer unless properly trained in IM injection technique.
- Do maintain a nutritious diet alongside the therapy.
8. Toxicology & Storage
Overdose: Unlikely with IM administration at recommended doses. Theoretical overdose could lead to: Nausea, restlessness, pruritus, urticaria, weakness, sweating, tachycardia, cyanosis, respiratory distress (due to anaphylactoid reactions to liver protein).
Storage: Store below 25°C. Protect from light and freezing. Keep the ampoule/vial in the outer carton. Keep out of reach and sight of children. Do not use after the expiry date. Discard any unused portion of an opened ampoule/vial immediately; the product does not contain preservatives.